P1107 How to Evaluate a Health Plan Change Request

Program	Manual Section
ALTCS	MA1107

Procedures

Outside the annual enrollment period, AHCCCS may only approve a health plan change under specific conditions. When a customer or representative requests a change of health plan outside the annual enrollment period, refer to the table below and take the appropriate action:

If the customer was assigned to their current ALTCS Health Plan based on…

Then...

Incorrect information
Agency error
Lack of initial enrollment choice
Lack of annual enrollment choice
Family continuity of care
Continuity of institutional or residential setting
Failure to correctly apply the 90-day re-enrollment policy (MA1105)

Email Eligibility System Support (ESS) to request the enrollment change.

The ESS will:

Contact the current ALTCS Health Plan;
Update PMMIS; and
Notify the Benefits and Eligibility Specialist of when the enrollment will change or the reason it cannot be changed.

Continuity of medical care for the customer other than institutional or residential setting; or
None of the above

Refer the customer to their current case manager; and
Advise the customer that the ALTCS health plan must agree to the change